CRITICAL INCIDENTS IN PAEDIATRIC ANAESTHESIA: DO THEY EXIST IN SPAIN TOO?
Romera A., Garrido A., Cabrerizo P., De Miguel A., López-Gil M.
This study reports the Spanish experience in critical incidents (CI) observed in paediatric anaesthesia from January 2009 to July 2015.
Since 2009, the Anaesthesia and Intensive Care National Incident Reporting System (SENSAR) - an organization that encompasses 86 Anaesthesia and Intensive Care Departments, Pain Management Units and Critical Care Units all over Spain – has analyzed more than 5.000 critical incidents regarding patient safety and suggested more than 9.900 corrective measures based on the data collected.
SENSAR is a non-profit, scientific organization that promotes patient safety by improving healthcare quality in anaesthesia, critical care and pain management environment. It works together with the Spanish  Society of Anaesthesia, the Spanish  Society of Pain (SEDAR) and the European Society of Anaesthesiology (ESA). It was born in 1999 as a local incident reporting system regarding patient safety in anaesthesia in the Hospital Universitario Fundación de Alarcón in Madrid, and it progressively developed over time to become, in 2009, a multihospital national system.
SENSAR collects data from a confidential, anonymous, voluntary and non-punitive online reporting system (ANESTIC) implemented in the enrolled hospitals. Reported incidents are analyzed by a team of local experts, using a method focus on system improvement rather than individuals’ and going beyond the more usual identification of fault and blame to generate a set of improvement strategies to tackle the system weaknesses that have been revealed. Each team follows the Protocol for the Investigation and Analysis of Clinical Incidents’ first published in 1999 by Vincent.
This national, multihospital system allows multiple teams to share experiences and develop coordinated measures. 
A CI is defined as any event that affected, or could have affected, the safety or the quality of care of the patient whilst under the care of a health system and can be reported by physicians or healthcare employees.
From January 2009 till July 2015, a total of 154 CI in children up to 16 years old were reported. Most of the patients, accounting for 80% (122), were healthy ASA I or II children. 33% (51) of them took place in children under the age of 2. Regarding the factors that may have contributed, we found that most CI were equipment failure related, 27% (42) were clinical incidents (of which 33% were respiratory events) and in third place (23 CI; 14%) we found medication errors. Of 154 incidents, 55 of them (33%) resulted in consequences for the patient: 2,6% (4) accounted for major morbidity, 17% (27) for medium morbidity and 20 (12,9%) for low morbidity.  No deads were reported. In 50% of the cases with major morbidity, corrective measures were adopted as a result of the incident reported.
SENSAR’s incidence of paediatric reporting was 2,8%, which is similar to that reported in other international studies. In those, however, most of the CI are clinical and airway related. As our results also confirm, infants and neonates below one year of age have a higher risk of having a critical incident, reported to be 2.5 times that of older children. Only 25 hospitals (30% of the total enrolled) report paediatric incidents. The online database does not give any data regarding type of patients or care provided by each hospital; therefore, important information is missing to take further conclusions. Paediatrics anesthetists should be encouraged to take ownership and contribute high-quality descriptions of incidents to national systems. Althought the data base needs further improvments, it is a useful tool that provides insight in the healthcare system and enhances patient safety.

Critical incidents in paediatric anaesthesia: do the exist in Spain too?